Hi,
@Labradorlover , I think docs sometimes assume that after a while T1s know the basic rules of the game, but it's surprising how often we don't.
I was unaware of many of them until I went on a DAFNE course. There's some blindingly obvious basic rules, once they are pointed out, but it's all too easy in the current system for them to be missed on the assumption that the T1 already knows them.
Personally, I wouldn't waste any money on a private consultant.
This is my take on basic rules, none of which involves paying money to a tube wearing an expensive suit who has read about hypos in books but never actually experienced one:
Get basal dose set right. Basal is meant to hold us steady between meals. If it's not set right, the whole of the rest of the show is a house built on sand - too high, we'll be feeding to stop drops, too low, we'll be bolusing with fast acting to stop rises.
It can be tested by not eating for 8 or so hours while relaxing and watching to see if it generally holds steady.
We can't advise on dosing but all the manufacturers publish starting points. Lantus, for example, suggests weight in kilos divided by 5. There's a surprising number of people have posted about bad experiences, and you then look at their weight and dosage and think ***, that's out by orders of magnitude.
Next rule up is the effect of 1u and 10g. As a very general guide, courses like DAFNE will say that 1u will drop by 2 to 3 and 10g will raise by 2 to 3. So, they say that, generally speaking, we need 1u for every 10g.
But that's a general rule - works for some, doesn't work for all. I, for example, use 1u for every 7g.
This takes a bit of time to experiment with, but it's well worth doing, because it takes the guess work out of it.
Wait until steady, eat 10g, see how much it raises her before steadying.
Wait till steady, inject 1u, wait to see how much it drops before steadying off.
Doing that sort of stuff, tedious though it is, will give a much clearer idea of how to balance insulin and food.
There's quite a few other factors to balance in to a dosing decision - amount of exercise past and future, whether trending up or down, any iob from a past dose etc. etc. - but that basic relationship between 1u and 10g is something well worthwhile learning as a starting point, and then adjust from there.
And she can cheat a lot with libre. It's still a postcode lottery at the moment, but more and more health areas are putting it on prescription. If not, it's about £70 per month if you've got a co-operative Superdrug pharmacy nearby.
We're having to deal with constantly moving blood sugar levels, 24 hours a day. Strips don't let you see those, they just give little snapshots of a moment in time, which is why a lot of us end up burned out and not caring.
Libre is a small sensor popped on top of the arm which reads levels continuously, so we can see where our levels have been, where they might be going, and take small, subtle steps to bring them back into line without any drama.
It makes managing T1 significantly easier, because we can now see in more or less real time what we are dealing with. It makes all those basal and 1u, 10g tests I mentioned above way easier.
There's also some decent books, all on kindle:
Think Like a Pancreas, Gary Scheiner
Sugar Surfing, Stephen Ponder
Beyond Fingersticks, William Lee Dubois
I was 21 when I was dx'd. Had a few bad times in the first few years, got through it. Your kid will be fine.
